Glutathione effect on functional and histological recovery after spinal cord injury in rats.

OBJECTIVE: The aim of this study was to evaluate the GSH effect on functional and histological recovery after experimental spinal cord injury in rats. METHODS: Forty Wistar rats were subjected to spinal cord injury through the Multicenter Animal Spinal Cord Injury Study (MASCIS) Impactor system. The rats were sorted and divided into four groups, as follows: Group 1 ‒ Laminectomy and spinal cord injury; Group 2 ‒ Laminectomy, spinal cord injury and Saline Solution (SS) 0.9%; Group 3 ‒ Laminectomy, spinal cord injury, and GSH; and Group 4 ‒ lLaminectomy without spinal cord injury. GSH and SS were administered intraperitoneally. Groups 1 and 4 received no intervention. RESULTS: The rats were evaluated for locomotor function recovery at seven different times by the Basso, Beattie, and Bresnahan (BBB) scale on days 2, 7, 14, 21, 28, 35, and 42 after the spinal cord injury. On day 42, the rats were sacrificed to analyze the histological findings of the injured spinal cord. In the group submitted to GSH, our experimental study revealed better functional scores on the BBB scale, horizontal ladder scale, and cranial and caudal axon count. The differences found were statistically significant in BBB scores and axonal count analysis. CONCLUSION: This study demonstrated that using glutathione in experimental spinal trauma can lead to better functional recovery and improved axonal regeneration rate in Wistar rats submitted to experimental spinal cord injury.

Evaluation of the effect of intrathecal GM1 in 24, 48, and 72 hours after acute spinal cord injury in rats.

OBJECTIVE: The aim of this study was to evaluate the best timing and feasibility of intrathecal application of sodium monosialoganglioside (GM1) after spinal cord contusion in Wistar rats as an experimental model. METHODS: Forty Wistar rats were submitted to contusion spinal cord injury after laminectomy. The animals were randomized and divided into four groups: Group 1 - Intrathecal application of GM1 24 hours after contusion; Group 2 - Intrathecal application of GM1 48 hours after contusion; Group 3 - intrathecal application of GM1 72 hours after contusion; Group 4 - Sham, with laminectomy and intrathecal application of 0.5 mL of 0.9% saline solution, without contusion. The recovery of locomotor function was evaluated at seven different moments by the Basso, Beattie, and Bresnahan (BBB) test. They were also assessed by the horizontal ladder, with sensory-motor behavioral assessment criteria, pre-and postoperatively. RESULTS: This experimental study showed better functional scores in the group submitted to the application of GM1, with statistically significant results, showing a mean increase when evaluated on known motor tests like the horizontal ladder and BBB, at all times of evaluation (p < 0.05), especially in group 2 (48 hours after spinal cord injury). Also, fewer mistakes and slips over the horizontal ladder were observed, and many points were achieved at the BBB scale analysis. CONCLUSION: The study demonstrated that the intrathecal application of GM1 after spinal cord contusion in Wistar rats is feasible. The application 48 hours after the injury presented the best functional results.

Epidemiology of vertebral fractures evaluated at iot-fmusp from 2019 to 2022 / Epidemiologia das fraturas vertebrais avaliadas no iot-fmusp de 2019 a 2022 / Epidemiología de fracturas vertebrales evaluadas en iot-fmusp del2019 al 2022

ABSTRACT: Objective: To determine the epidemic profile of patients with spinal fractures referred for evaluation by Spine Group of IOT-HCFMUSP between 2019 and 2022. To enable the effect of the Covid-19 Pandemic on these epidemic profiles. Methods: We retrospectively analyzed the medical records of patients with spinal fractures referred by the São Paulo Center for the Regulation of Health Offers and Services (CROSS) to the Spine Group of IOT-HCFMUSP between 2019 and 2022. The epidemiological profile between the pre-pandemic Covid-19 period and the period of the Covid-19 pandemic until December 2022 in the city of São Paulo was compared. Results: The medical records of 427 patients were analyzed between March 2019 and December 2022. During the period, males accounted for 71.9% of cases, and the mean age was 46.7 years. Falls from heights were the most frequent trauma mechanism (63.7%), followed by motorcycle accidents (14.3%). The absence of neurological deficit occurred in 76.8% of the cases, and the most injured region was the lumbar region (39.3%). There were changes in the epidemiological profile during the Covid-19 pandemic compared to the pre-pandemic. Conclusions: A predominance of middle-aged males was observed, in addition to the trauma mechanism of falling from a height, as well as the absence of a neurological deficit in the initial evaluation. The lumbar and cervical regions were the most frequent sites of injury. The pandemic period interfered with the epidemiological profile presented and in the time interval between the injury and the evaluation at the IOT-HCFMUSP. Level of Evidence IV; Case Series.

RESUMO: Objetivos: Determinar o perfil epidemiológico dos pacientes com fraturas na coluna vertebral encaminhados para avaliação pelo Grupo de Coluna do IOT-HCFMUSP entre 2019 e 2022. Avaliar o efeito da Pandemia de Covid-19 sobre esse perfil epidemiológico. Métodos: Foram analisados retrospectivamente os prontuários dos pacientes com fratura na coluna encaminhados pela Central de Regulação de Ofertas e Serviços de Saúde (CROSS) de São Paulo ao Grupo de Coluna do IOT-HCFMUSP entre os anos de 2019 e 2022. Foi comparado o perfil epidemiológico entre o período pré-pandemia Covid-19 e o período de pandemia Covid-19 até dezembro de 2022 na cidade de São Paulo. Resultados: Analisou-se o prontuário médico de 427 pacientes entre março de 2019 e dezembro de 2022. No período o sexo masculino correspondeu a 71,9% dos casos, a média da idade foi de 46,7 anos. Queda de altura foi o mecanismo de trauma mais frequente (63,7%), seguido de acidentes de motocicleta (14,3%). A ausência de déficit neurológico ocorreu em 76,8% dos casos, bem como a região mais lesada foi a lombar (39,3%). Houveram mudanças no perfil epidemiológico durante a pandemia de Covid 19 em relação à pré-pandemia. Conclusões: Observado predomínio do sexo masculino de meia idade, além do mecanismo de trauma de queda de altura, bem como ausência de déficit neurológico a avaliação inicial. A região lombar e cervical foram os locais mais frequentes de lesão. O período pandêmico interferiu no perfil epidemiológico apresentado e nos intervalos de tempo entre a lesão e a avaliação no IOT-HCFMUSP. Nível de Evidência IV; Série de Casos.

RESUMEN: Objetivos: Determinar la epidemiología de los pacientes con fracturas vertebrales evaluadas por el Grupo de Columna IOT-HCFMUSP entre 2019 y 2022. Evaluar el efecto de la Pandemia Covid-19 sobre esta epidemiología. Métodos: Análisis retrospectivo de historias clínicas de pacientes con fracturas de columna remitidos por el Central de Regulação de Ofertas e Serviços de Saúde (CROSS) de São Paulo al Grupo de Columna IOT-HCFMUSP entre 2019 y 2022. Se comparó el perfil epidemiológico entre el periodo de la pre-pandemia de Covid-19 y el período de pandemia de Covid-19 hasta diciembre de 2022. Resultados: Serie de casos de 427 pacientes entre marzo de 2019 y diciembre de 2022. En el período, el sexo masculino representó el 71,9% de los casos, la edad promedio fue de 46,7 años. La caída de altura fue el mecanismo traumático más común (63,7%), seguido de los accidentes de motocicleta (14,3%). La ausencia de déficit neurológico se presentó en el 76,8% de los casos, siendo la región lumbar (39,3%) la región más lesionada. Hubo cambios en el perfil epidemiológico durante la pandemia de Covid-19 con relación a la prepandemia. Conclusiones: Hubo predominio del sexo masculino, caídas de altura como mecanismo traumático y ausencia de déficit neurológico en la evaluación inicial. La región lumbar y cervical fueron los sitios de lesión más frecuentes. El período pandémico interfirió con el perfil epidemiológico presentado y los intervalos de tiempo entre la lesión y la evaluación en el IOT-HCFMUSP.

Evaluation of the effect of intrathecal GM1 in 24, 48, and 72 hours after acute spinal cord injury in rats

Abstract Objective The aim of this study was to evaluate the best timing and feasibility of intrathecal application of sodium monosialoganglioside (GM1) after spinal cord contusion in Wistar rats as an experimental model. Methods Forty Wistar rats were submitted to contusion spinal cord injury after laminectomy. The animals were randomized and divided into four groups: Group 1 - Intrathecal application of GM1 24 hours after contusion; Group 2 - Intrathecal application of GM1 48 hours after contusion; Group 3 - intrathecal application of GM1 72 hours after contusion; Group 4 - Sham, with laminectomy and intrathecal application of 0.5 mL of 0.9% saline solution, without contusion. The recovery of locomotor function was evaluated at seven different moments by the Basso, Beattie, and Bresnahan (BBB) test. They were also assessed by the horizontal ladder, with sensory-motor behavioral assessment criteria, pre-and postoperatively. Results This experimental study showed better functional scores in the group submitted to the application of GM1, with statistically significant results, showing a mean increase when evaluated on known motor tests like the horizontal ladder and BBB, at all times of evaluation (p < 0.05), especially in group 2 (48 hours after spinal cord injury). Also, fewer mistakes and slips over the horizontal ladder were observed, and many points were achieved at the BBB scale analysis. Conclusion The study demonstrated that the intrathecal application of GM1 after spinal cord contusion in Wistar rats is feasible. The application 48 hours after the injury presented the best functional results.

Epidemiological profile in a tertiary admission unit of spine diseases / Perfil epidemiológico em uma unidade de internação terciária de doenças da coluna vertebral / Perfil epidemiológico en una unidad de internación terciaria de patologias de la columna vertebral

ABSTRACT: Introduction: In March 2020, WHO officially decreed that the world was going through a pandemic, that of Covid-19. In May 2022, in Brazil, the end of measures to deal with the pandemic was decreed. In 2022, there was a movement to return to normal care in the provision of care. Objective: In the present study, we carried out a retrospective descriptive analysis of the epidemiological scenario of the ward of the Spine Group at the Hospital das Clínicas of the Faculty of Medicine of the Universidade de São Paulo (HC-FMUSP). Method: Data analysis was performed from information gathered in patients' medical records. Results: In the analyzed period, there were 152 consultations in hospitalization, with the main cause being spinal trauma. Of all the cases, only 23.68% were scheduled on an elective basis, which despite being a lower than expected number, was shaped by the demands of urgent care channeled to the service in question. Conclusion: Despite a higher number of cases hospitalized in the post-pandemic period, there is still the expectancy of more elective cases to be treated in the future. Level of Evidence III; Retrospective Case Series Study.

RESUMO: Introdução: Em março de 2020, a OMS decretou oficialmente que o mundo atravessava uma pandemia, a Covid-19. Em maio de 2022, no Brasil, decretou-se o fim das medidas de enfrentamento à pandemia. No ano de 2022, houve um movimento de retorno à normalidade assistencial na prestação de atendimentos. Objetivo: No presente estudo, realiza-se uma análise retrospectiva descritiva do cenário epidemiológico da enfermaria do Grupo de Coluna Vertebral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Método: A análise dos dados foi efetuada a partir do levantamento de prontuários médicos. Resultados: No período analisado, houveram 152 atendimentos em regime de internação, com a principal causa sendo o traumatismo da coluna vertebral. De todos os casos, apenas 23,68% foram casos agendados em regime eletivo, o que apesar de ser um número abaixo do esperado, foi moldado pelas demandas dos atendimentos de urgência canalizados ao serviço em questão. Conclusão: Apesar do aumento de atendimentos no período pós pandemia, há espaço para maior retomada do volume de casos eletivos no futuro. Nível de Evidência III; Estudo Retrospectivo de Série de Casos.

RESUMEN: Introdución: En marzo de 2020, la OMS decretó oficialmente que el mundo atravesaba una pandemia, la del Covid-19. En mayo de 2022, en Brasil, se decretó el fin de las medidas para enfrentar la pandemia. En el año 2022, hubo un movimiento para volver a la atención normal en la prestación de cuidados. Objetivo: En el presente estudio, realizamos un análisis descriptivo retrospectivo del escenario epidemiológico de la sala del Grupo de Columna Vertebral del Hospital das Clínicas de la Facultad de Medicina de la Universidade de São Paulo (HC-FMUSP). Método: El análisis de los datos se realizó con acceso al prontuario médico de los pacientes. Resultados: En el período analizado, hubo 152 consultas en hospitalización, siendo la principal causa trauma espinal. Del total de casos, solo el 23,68% fueron programados de forma electiva que, a pesar de ser un número inferior al esperado, estuvo condicionado por las demandas de atención urgente canalizadas al servicio en cuestión. Conclusión: A pesar del aumento de asistencias en el período postpandemia, hay espacio para una mayor recuperación futura en el volumen de casos electivos. Nivel de Evidencia III; Estudio Retrospectivo de Serie de Casos.

IMPACT OF THE COVID-19 PANDEMIC ON SPINE SURGERY IN A TERTIARY HEALTH CARE INSTITUTION.

Objectives: To assess postoperative complications, including COVID-19 infection, among patients undergoing surgeries at a tertiary institution during the pandemic, and to develop a local epidemiological profile of spine surgery patients. Methods: Retrospective descriptive study of all patients who underwent spine surgery between March 2020 and 14 January 2021 in a tertiary institution in Latin America. All patients who underwent spine surgery were included, without age restrictions. The main outcomes were postoperative complications, including COVID-19 infection. Results: 74 patients were included in the study, 43 males and 31 females. The average age was 49.6 years. The mean duration of hospitalization was 11.5 days. Urgent surgeries were performed in 60.81% of cases. During hospitalization, only 5 of 74 patients were diagnosed with COVID-19, and only 1 patient had pulmonary involvement estimated to be greater than 50%. On average, 1.9 surgical debridements were required after postoperative surgical site infection. Conclusions: During the hospitalization period, only 6.7% of patients were diagnosed with COVID-19 infection. The COVID-19 infection death rate was 1 in 5 cases. The postoperative surgical site infection rate was 10.8%, similar to the level before the pandemic. Level of Evidence IV; Observational retrospective descriptive study .

Objetivos: Avaliar complicações pós-cirúrgicas, incluindo infecções por COVID-19, entre pacientes cirúrgicos numa instituição terciária de saúde durante a pandemia, e desenvolver um perfil epidemiológico local de pacientes de cirurgias da coluna. Métodos: estudo descritivo e retrospectivo de todos os pacientes que passaram por cirurgias da coluna entre março de 2020 e 14 de janeiro de 2021, numa instituição terciária na América Latina. Todos os pacientes que passaram por cirurgias na coluna foram incluídos, sem restrição de idade. Os principais resultados foram complicações pós-cirúrgicas, incluindo a infecção por COVID-19. Resultados: 74 pacientes foram incluídos no estudo, 43 do sexo masculino e 31 do feminino. A média de idade foi de 49.6 anos. A duração média da hospitalização foi de 11.5 dias. Cirurgias urgentes foram realizadas em 60.81% dos casos. Durante a hospitalização, apenas 5 dos 74 pacientes foram diagnosticados com COVID-19, e apenas 1 deles teve envolvimento pulmonar estimado em mais que 50%. Em média, 1,9 desbridamentos cirúrgicos foram necessários após infecção do sítio cirúrgico. Conclusões: Durante o período de hospitalização, apenas 6,37% dos pacientes foram diagnosticados com infeção por COVID-19. A taxa de mortes devido à infecção por COVID-19 foi de 1 em 5. Infecções do sítio cirúrgico atingiram uma taxa de 10.8%, nível similar àquele prévio à pandemia. Nível de evidência IV ; Estudo observacional retrospectivo descritivo .

Impact of the covid-19 pandemic on spine surgery in a tertiary health care institution / Impacto da pandemia de covid-19 nas cirurgias de coluna em uma instituição terciária de saúde

ABSTRACT Objectives: To assess postoperative complications, including COVID-19 infection, among patients undergoing surgeries at a tertiary institution during the pandemic, and to develop a local epidemiological profile of spine surgery patients. Methods: Retrospective descriptive study of all patients who underwent spine surgery between March 2020 and 14 January 2021 in a tertiary institution in Latin America. All patients who underwent spine surgery were included, without age restrictions. The main outcomes were postoperative complications, including COVID-19 infection. Results: 74 patients were included in the study, 43 males and 31 females. The average age was 49.6 years. The mean duration of hospitalization was 11.5 days. Urgent surgeries were performed in 60.81% of cases. During hospitalization, only 5 of 74 patients were diagnosed with COVID-19, and only 1 patient had pulmonary involvement estimated to be greater than 50%. On average, 1.9 surgical debridements were required after postoperative surgical site infection. Conclusions: During the hospitalization period, only 6.7% of patients were diagnosed with COVID-19 infection. The COVID-19 infection death rate was 1 in 5 cases. The postoperative surgical site infection rate was 10.8%, similar to the level before the pandemic. Level of Evidence IV; Observational retrospective descriptive study .

RESUMO Objetivos: Avaliar complicações pós-cirúrgicas, incluindo infecções por COVID-19, entre pacientes cirúrgicos numa instituição terciária de saúde durante a pandemia, e desenvolver um perfil epidemiológico local de pacientes de cirurgias da coluna. Métodos: estudo descritivo e retrospectivo de todos os pacientes que passaram por cirurgias da coluna entre março de 2020 e 14 de janeiro de 2021, numa instituição terciária na América Latina. Todos os pacientes que passaram por cirurgias na coluna foram incluídos, sem restrição de idade. Os principais resultados foram complicações pós-cirúrgicas, incluindo a infecção por COVID-19. Resultados: 74 pacientes foram incluídos no estudo, 43 do sexo masculino e 31 do feminino. A média de idade foi de 49.6 anos. A duração média da hospitalização foi de 11.5 dias. Cirurgias urgentes foram realizadas em 60.81% dos casos. Durante a hospitalização, apenas 5 dos 74 pacientes foram diagnosticados com COVID-19, e apenas 1 deles teve envolvimento pulmonar estimado em mais que 50%. Em média, 1,9 desbridamentos cirúrgicos foram necessários após infecção do sítio cirúrgico. Conclusões: Durante o período de hospitalização, apenas 6,37% dos pacientes foram diagnosticados com infeção por COVID-19. A taxa de mortes devido à infecção por COVID-19 foi de 1 em 5. Infecções do sítio cirúrgico atingiram uma taxa de 10.8%, nível similar àquele prévio à pandemia. Nível de evidência IV ; Estudo observacional retrospectivo descritivo .

Comparison between start back screening tool and dram for detection of psychosocial factors in low back pain / Comparação entre start back screening tool e dram na detecção de fatores psicossociais em dor lombar / Comparación entre start back screening tool y dram en la detección de factores psicosociales en dolor lumbar

ABSTRACT Objective: To correlate the results of the STarT Back Screening Tool and DRAM questionnaires, applied simultaneously, in a population with low back pain. Methods: Comparative cross-sectional study with 84 participants with low back pain assessed by both STarT Back Screening Tool (SBST) and DRAM questionnaires. The degree of correlation between the two questionnaires was analyzed through the evaluation of individualized data and using the Spearman correlation coefficient. Results: According to the DRAM, 19% of the patients were classified as "normal", 32.1% as "at risk" and 48.8% as "distressed". According to SBST, 59.5% of patients were classified as "low risk", 31% as "medium risk" and 9.5% as "high risk". Applying the Spearman's coefficient to evaluate the degree of correlation between the two questionnaires, a value of 0.4 was obtained. This shows that there is a positive, but weak, correlation (p <0.001) between the two questionnaires. Conclusion: There is a positive correlation between the two questionnaires, but the DRAM showed a greater tendency to classify patients with some degree of psychological distress when compared to the SBST. Both questionnaires are effective in identifying these factors, but the data suggest that the DRAM may be more effective as a screening tool in patients with low back pain, in view of the higher number of patients identified. Level of evidence III; Diagnostic test study.

RESUMO Objetivo: Correlacionar os resultados dos questionários STarT Back Tool e DRAM, aplicados em um único tempo, a uma população com dor lombar. Métodos: Estudo transversal comparativo com 84 participantes portadores de dor lombar baixa submetidos aos questionários STarT Back Screening Tool (SBST) e DRAM. O grau de correlação entre os dois questionários foi analisado pela avaliação dos dados individualizados e do coeficiente de correlação de Spearman. Resultados: De acordo com o DRAM, 19% dos pacientes foram classificados como "normais", 32,1% "em risco" e 48,8% se enquadraram no subgrupo "distressed". De acordo com o SBST, 59,5% dos pacientes foram classificados como "baixo risco", 31% "risco médio" e 9,5% "alto risco". Ao aplicar o coeficiente de Spearman para avaliar o grau de correlação entre os dois questionários, foi obtido o valor de 0,4. Isso mostra que há uma correlação positiva entre os dois questionários, embora seja considerada correlação fraca (p < 0,001). Conclusão: Há uma correlação positiva entre os dois questionários, porém o DRAM mostrou tendência maior a identificar pacientes com algum grau de transtorno psíquico quando comparado com o SBST. Ambos os questionários são efetivos para identificar esses fatores, mas os dados sugerem que o DRAM talvez seja mais efetivo como ferramenta de triagem em pacientes com dor lombar baixa, em virtude do maior número de doentes identificados. Nível de evidência III; Estudo diagnóstico.

RESUMEN Objetivo: Correlacionar los resultados de los cuestionarios STarT Back Tool y DRAM, aplicados de una sola vez, en una población con dolor lumbar. Métodos: Estudio transversal comparativo con 84 participantes con dolor lumbar evaluados por los cuestionarios STarT Back Screening Tool (SBST) y DRAM. El grado de correlación entre los dos cuestionarios se analizó mediante la evaluación de datos individualizados y del coeficiente de correlación de Spearman. Resultados: Según DRAM, el 19% de los pacientes fue clasificado como "normal", el 32,1% como " en riesgo" y el 48,8% se encuadró en el subgrupo "distressed". Según SBST, el 59,5% de los pacientes fue considerado como de "bajo riesgo", el 31% de "riesgo medio" y el 9,5% de "alto riesgo". Al aplicar el coeficiente de Spearman para evaluar el grado de correlación entre los dos cuestionarios, se obtuvo un valor de 0,4. Ello demuestra que existe una correlación positiva, pero débil (p <0,001) entre los dos cuestionarios. Conclusión: Existe una correlación positiva entre los dos cuestionarios, pero DRAM mostró una mayor tendencia a identificar pacientes con algún grado de trastorno psicológico en comparación con SBST. Ambos cuestionarios son eficaces para identificar estos factores, pero los datos sugieren que DRAM puede ser más eficaz como herramienta de detección en pacientes con dolor lumbar, debido al mayor número de pacientes identificados. Nivel de evidencia III; Estudio diagnóstico.

Epidemiology of vertebral spine fractures in a hospital in são paulo in the two-year period 2017-2018 / Epidemiologia das fraturas da coluna vertebral em hospital de são paulo no biênio 2017-2018 / Epidemiología de las fracturas de la columna vertebral en un hospital de são paulo en el período de 2017-2018

ABSTRACT Objectives: To evaluate the epidemiological profile of patients with spinal fractures over a two-year period (2017 and 2018) in a quaternary hospital in the city of São Paulo. Methods: A cross-sectional study was carried out through the analysis of the electronic medical records of patients treated by the Spine group of the Department of Orthopedics and Traumatology at the Orthopedics and Traumatology Emergency Room of Hospital das Clínicas de São Paulo in the years 2017 and 2018. Results: A total of 185 patients were evaluated over two years. Males were the gender most frequently evaluated (69.19%), and the mean patient age was 43.95 years. The most common trauma mechanisms were falls from a height (45.95%) and traffic accidents (29.73%). The cervical spine, affected in 28.65%, was the most affected region, followed by the thoracolumbar region (26.56%). Most patients did not present deficits at the initial moment (71.89%) and 54.05% of patients underwent surgery for treatment. Conclusion: Most traumas involving the spine affect adults of working age (from 20 to 60 years old), with a predominance of males. Most injuries occurred in the cervical region, which is the region most commonly associated with severe trauma and neurological injuries. This study can help in planning prevention and precaution strategies for spinal trauma. Level of evidence III; Cross-sectional study.

RESUMO Objetivos: Avaliar o perfil epidemiológico dos pacientes com fraturas da coluna vertebral no período de dois anos (2017 e 2018) em hospital quaternário da cidade de São Paulo. Métodos: Foi realizado um estudo transversal mediante análise dos prontuários eletrônicos de pacientes atendidos pelo grupo de Coluna do Departamento de Ortopedia e Traumatologia no Pronto Socorro de Ortopedia e Traumatologia do Hospital das Clínicas de São Paulo nos anos de 2017 e 2018. Resultados: Um total de 185 pacientes foram avaliados ao longo de dois anos. O sexo masculino foi predominante na avaliação (69,19%), e a média de idade dos pacientes de foi de 43,95 anos. Os mecanismos de trauma mais comuns foram queda de altura (45,95%) e acidentes de trânsito (29,73%). A coluna cervical, acometida em 28,65%, foi a mais afetada, seguida pela região toracolombar (26,56%). A maioria dos pacientes não apresentava déficits no momento inicial (71,89%) e 54,05% dos pacientes foram submetidos a cirurgia para o tratamento. Conclusão: A maioria dos traumas envolvendo a coluna vertebral acometem a população economicamente ativa (dos 20 aos 60 anos), com predomínio no sexo masculino. A maioria das lesões ocorreram na região cervical, que é a região mais comumente associada a traumas graves e lesões neurológicas. Este estudo pode ajudar a planejar estratégias de prevenção e precaução dos traumas da coluna vertebral. Nível de evidência III; Estudo transversal.

RESUMEN Objetivos: Evaluar el perfil epidemiológico de pacientes con fracturas de columna vertebral en un período de dos años (2017 y 2018) en un hospital cuaternario de la ciudad de São Paulo. Métodos: Se realizó un estudio transversal mediante el análisis de historias clínicas electrónicas de pacientes atendidos por el grupo de Columna Vertebral del Departamento de Ortopedia y Traumatología de la Sala de Emergencias de Ortopedia y Traumatología del Hospital de Clínicas de São Paulo en 2017 y 2018. Resultados: Se evaluó a un total de 185 pacientes durante dos años. En la evaluación predominó el sexo masculino (69,19%), siendo la edad promedio de los pacientes de 43,95 años. Los mecanismos traumatológicos más frecuentes fueron las caídas de altura (45,95%), seguidos de los accidentes de tráfico (29,73%). La columna cervical, afectada en un 28,65%, fue la más afectada, seguida de la región toracolumbar (26,56%). La mayoría de los pacientes no tenían déficits al inicio del estudio (71,89%) y el 54,05% de ellos fueron sometidos a cirugía para su tratamiento. Conclusión: La mayoría de los traumatismos que involucran la columna afectan a la población económicamente activa (20 a 60 años), con predominio del sexo masculino. La mayoría de las lesiones se produjeron en la región cervical, que es la región más comúnmente asociada a los traumatismos graves ya las lesiones neurológicas. Este estudio puede ayudar a planificar estrategias de prevención y precaución de los traumatismos de la columna vertebral. Nivel de evidencia III; Estudio transversal.

Tomographic analysis of c7, t1 and t2 vertebrae anatomy in children / Estudo tomográfico das vértebras c7, t1 e t2 em crianças

ABSTRACT Objective: To evaluate and compare anatomical measurements of C7, T1 and T2 vertebrae in children from 3 to 12 years of age to provide useful epidemiological data for determining the safe anatomical margin for transpedicular and translaminar fixation with screws in this population. Methods: This observational retrospective cross-sectional study evaluated 76 computed tomography scans obtained over 6 months, analyzing the following parameters: the angle of attack, length, thickness and diameter of the pedicle; and the angle of attack, length and thickness of the lamina. Results: The lamina length and thickness, as well as pedicle length varied in size according to age. Although the angle of attack was similar across different ages, age-dependent variation occurred in the T1 vertebra. Conclusion: Screws with a 3.5 mm diameter are safe to use in the C7 and T2 pedicles, while the T1 pedicle allows the introduction of larger screws ranging from 3.5-4.5 mm in diameter. In the lamina, 3.5 mm screws are safe for use only in children older than 7 years. However, each case should be analyzed individually, with the present study not aiming to replace the preoperative use of CT. Level of Evidence III, Retrospective comparative study.

RESUMO Objetivo: Avaliar e comparar as medidas anatômicas das vértebras C7, T1 e T2 em crianças de 3 a 12 anos de modo a determinar margens seguras para fixação transpedicular e translaminar com parafusos nessa população. Métodos: Estudo transversal retrospectivo observacional. Um total de 76 tomografias computadorizadas foram analisadas em um período de 6 meses. Os seguintes parâmetros foram analisados: ângulo de ataque, comprimento, espessura e diâmetro do pedículo, comprimento e espessura da lâmina. Resultados: O comprimento e espessura da lâmina bem como o comprimento do pedículo aumenta em tamanho conforme a idade. Enquanto o ângulo de ataque permanece estável conforme variação de idade; variação dependente da idade ocorre somente na vértebra T1. Conclusão: Parafusos com diâmetro de 3.5mm podem ser inseridos de maneira segura nos pedículos de C7 e T2. Já no pedículo de T1 pode-se inserir parafusos com medidas de 3.5 a 4.5mm de diâmetro de maneira segura. Na lâmina, parafusos de 3.5mm podem ser usados de maneira segura somente em crianças maiores de 7 anos. No entanto, cada caso deve ser analisado de maneira individualizada, e o presente estudo não objetivo substituir o uso de tomografia computadorizada no pré-operatório. Nível de Evidência III, Estudo Comparativo Retrospectivo.

TOMOGRAPHIC ANALYSIS OF C7, T1 AND T2 VERTEBRAE ANATOMY IN CHILDREN.

OBJECTIVE: To evaluate and compare anatomical measurements of C7, T1 and T2 vertebrae in children from 3 to 12 years of age to provide useful epidemiological data for determining the safe anatomical margin for transpedicular and translaminar fixation with screws in this population. METHODS: This observational retrospective cross-sectional study evaluated 76 computed tomography scans obtained over 6 months, analyzing the following parameters: the angle of attack, length, thickness and diameter of the pedicle; and the angle of attack, length and thickness of the lamina. RESULTS: The lamina length and thickness, as well as pedicle length varied in size according to age. Although the angle of attack was similar across different ages, age-dependent variation occurred in the T1 vertebra. CONCLUSION: Screws with a 3.5 mm diameter are safe to use in the C7 and T2 pedicles, while the T1 pedicle allows the introduction of larger screws ranging from 3.5-4.5 mm in diameter. In the lamina, 3.5 mm screws are safe for use only in children older than 7 years. However, each case should be analyzed individually, with the present study not aiming to replace the preoperative use of CT. Level of Evidence III, Retrospective comparative study.

OBJETIVO: Avaliar e comparar as medidas anatômicas das vértebras C7, T1 e T2 em crianças de 3 a 12 anos de modo a determinar margens seguras para fixação transpedicular e translaminar com parafusos nessa população. MÉTODOS: Estudo transversal retrospectivo observacional. Um total de 76 tomografias computadorizadas foram analisadas em um período de 6 meses. Os seguintes parâmetros foram analisados: ângulo de ataque, comprimento, espessura e diâmetro do pedículo, comprimento e espessura da lâmina. RESULTADOS: O comprimento e espessura da lâmina bem como o comprimento do pedículo aumenta em tamanho conforme a idade. Enquanto o ângulo de ataque permanece estável conforme variação de idade; variação dependente da idade ocorre somente na vértebra T1. CONCLUSÃO: Parafusos com diâmetro de 3.5mm podem ser inseridos de maneira segura nos pedículos de C7 e T2. Já no pedículo de T1 pode-se inserir parafusos com medidas de 3.5 a 4.5mm de diâmetro de maneira segura. Na lâmina, parafusos de 3.5mm podem ser usados de maneira segura somente em crianças maiores de 7 anos. No entanto, cada caso deve ser analisado de maneira individualizada, e o presente estudo não objetivo substituir o uso de tomografia computadorizada no pré-operatório. Nível de Evidência III, Estudo Comparativo Retrospectivo.

Risk Factors Associated with Postoperative Infection in Cancer Patients Undergoing Spine Surgery.

OBJECTIVES: To determine the rate of and main risk factors for postoperative infection in cancer patients who underwent spine surgery in the last 5 years in order to determine whether there is an association between postoperative infection and increased mortality during hospitalization. METHODS: All cancer patients who underwent surgical procedures between January 2015 and December 2019 at a single hospital specializing in spine cancer surgery were analyzed. The primary outcome of interest was postoperative infection. Bivariate logistic regression was used to estimate the odds ratio and 95% confidence interval for each variable in relation to the occurrence of infection. RESULTS: We evaluated 324 patients, including 176 men (54.3%) and 148 women (45.7%) with a mean age of 56 years. The incidence of postoperative infection was 20.37%. Of the 324 patients, 39 died during hospitalization (12%). CONCLUSIONS: Surgical time greater than 4 hours, surgical instrumented levels greater than 6, and an Eastern Cooperative Oncology Group of 3 or 4 were associated with an increased risk of postoperative infection, but these factors did not lead to an increase in mortality during hospitalization.

Adult Degenerative Scoliosis.

Populational aging increases the incidence of musculoskeletal degenerative processes, such as adult scoliosis (AS). Adult scoliosis is defined as a spinal deformity in the coronal plane with a Cobb angle > 10°. Adult scoliosis may be iatrogenic or result from a degenerative process (scoliosis de novo ) or a pre-existing scoliosis. Adult scoliosis is a potentially limiting condition that affects a heterogeneous group of patients. Clinical treatment proved to be ineffective and surgery is often indicated. The present paper reviews AS pathophysiology, clinical presentation and diagnosis, in addition to surgical indications and the main techniques currently used.

Assessment of the Accuracy of the AO Spine-TL Classification for Thoracolumbar Spine Fractures Using the AO Surgery Reference Mobile App.

STUDY DESIGN: Cohort study. OBJECTIVES: This study aimed to evaluate the accuracy of the AO Surgery Reference mobile app in the diagnosis of thoracolumbar fractures of the spine according to the AO TL classification, and to discuss the usefulness of this app in the teaching and training of the resident physicians in orthopedics and traumatology area. METHODS: The 24 residents of Orthopedic and Traumatology program assessed 20 cases of thoracolumbar fractures selected from the hospital database on 2 different occasions, with a 30-day interval, and they classified these cases with and without using the AO Surgery Reference app. A group of spine experts previously established the gold standard and the answers were statistically compared, with the inter- and intraobserver reliability evaluated by the kappa index. RESULTS: The use of the AO Surgery Reference app increased the classification success rate of the fracture morphology (from 53.4% to 72.5%), of the comorbidity modifier (from 61.4% to 77.9%) and of the neurological status modifier (from 55.1% to 72.9%). In addition, the mobile app raised the classification agreement and accuracy. The kappa index increased from 0.30 to 0.53 regarding the morphological classification of fractures. CONCLUSIONS: The residents improved their ability to recognize and classify thoracolumbar spine fractures, which reinforces the importance of this tool in medical education and clinical practice.

Comparative tomographic study of the iliac screw and the S2-alar-iliac screw in children.

OBJECTIVES: The recent advancements in spine fixation aid in the treatment of complex spinal pathologies. Both the iliac screw (IS) and the S2-alar-iliac (S2AI) screw provide adequate stability in the fixation of complex lumbosacral spine pathologies, leading to a significant increased rate of using these techniques in the daily practice of the spine surgeons. This study aims to analyze, describe, and compare the insertion and positioning parameters of the S2AI screw and IS techniques in children without spinal deformities. METHODS: An observational retrospective study was conducted at a university hospital in 2018, with 25 computed tomography (CT) images selected continuously. Mann-Whitney-Shapiro-Wilk tests were performed. The reliability of the data was assessed using the intraclass correlation. The data were stratified by age group only for Pearson's correlation analysis. RESULTS: The mean age was 11.7 years (4.5 SD). The mean IS length was 106.63 mm (4.59 SD). The mean length of the S2AI screw was 104.13 mm (4.22 SD). The mean skin distance from the IS entry point was 28.13 mm (4.27 SD) and that for the S2AI screw was 39.96 mm (4.54 SD). CONCLUSIONS: Through CT, the S2AI screw trajectory was observed to have a greater bone thickness and skin distance than the IS. There was a linear correlation between age and screw length for both techniques. A similar relationship was observed between skin distance and age for the S2AI screw technique. In children, the S2AI screw technique presents advantages such as greater cutaneous coverage and implant thickness than the IS technique.

Clinical and Radiological Results After Minimally Invasive Transpsoas Lateral Access Surgery for Degenerative Lumbar Stenosis.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: The lateral transpsoas access is a retroperitoneal approach for the lumbar spine to perform the lateral lumbar interbody fusion (LLIF), an intersomatic arthrodesis performed with a cage placed on the lateral borders of the epiphyseal ring. The procedure can be used to provide indirect decompression of the nervous structures through the discectomy and restoration of the disc height. The objective of the present study was to evaluate the indirect decompression following LLIF both with radiological and clinical parameters. METHODS: Prospective clinical and radiological study in a single center with 20 patients diagnosed with 1- or 2-level degenerative lumbar stenosis. Radiological analysis on magnetic resonance imaging included foramen height, canal area, canal diameter, and disc height. Clinical outcomes included visual analogue scale (VAS) and Oswestry Disability Index (ODI) collected up to 12 months. Complications and reoperations were recorded. RESULTS: In total, 25 levels were treated. No reoperation was required. Disc height was increased by an average of 25% (P < .001). The canal area increased from 109 to 149 mm2 (P < .001) and from 9.3 to 12.2 mm (P < .001) in anteroposterior diameter. The foramen area demonstrated the effect of indirect decompression on both sides (P < .001). The height of the foramen showed significant average increase of 2.8 mm (P < .001). The results from VAS and ODI questionnaires confirmed the clinical effect of indirect decompression. CONCLUSION: We observed that indirect decompression by the LLIF method is feasible both radiologically and clinically with a low rate of complications and reoperations.

Percutaneous Endoscopic Lumbar Discectomy Versus Microdiscectomy for the Treatment of Lumbar Disc Herniation: Pain, Disability, and Complication Rate-A Randomized Clinical Trial.

PURPOSE: The objective was to compare the traditional microdiscectomy with percutaneous endoscopic lumbar discectomy for the treatment of disc herniations regarding pain, disability, and complications. METHODS: Randomized clinical trial with 47 patients with disc herniations treated with 2 different surgical techniques: traditional microdiscectomy or percutaneous endoscopic lumbar discectomy. Forty-seven patients were divided into 2 groups and monitored for 12 months. Irradiated and low back pain were evaluated with the visual analog scale. Surgery complications were recorded. RESULTS: After surgery, the sciatica and disability improved significantly but without significant differences between the groups. Improvements in back pain were significant until the third month. There were no statistical differences between groups regarding recurrence, infection, and the need for reoperation. CONCLUSIONS: Endoscopic discectomy results are similar to those of conventional microdiscectomy regarding pain and disability improvement. Postoperative lumbar pain is less intense with endoscopic discectomy than conventional microdiscectomy only during the first 3 months. Endoscopic discectomy is a safe and efficient alternative to microdiscectomy. CLINICAL TRIALS: Trial protocol registration number: RBR-5symrd (http://www.ensaiosclinicos.gov.br).

Does Kyphectomy Improve the Quality of Life of Patients With Myelomeningocele?

BACKGROUND: Lumbar kyphosis is a complex spinal deformity occurring in approximately 8% to 20% of patients with myelomeningocele. The resulting gibbosity may cause pressure ulcers, difficulty lying down in the supine position and sitting on the ischia without support, decreasing quality of life (QOL). Surgery is generally performed to correct kyphosis and maintain vertebral alignment, but high complication rates have been reported. Despite satisfactory radiological results, the impact of surgery and its complications on health-related QOL (HRQOL) has not yet been established. QUESTIONS/PURPOSES: Among children with myelomeningocele undergoing corrective surgery for lumbar kyphosis: (1) What is the risk of complications and reoperation after this procedure? (2) Does this procedure improve HRQOL scores in these patients? METHODS: Between 2012 and 2013, five surgeons at three centers treated 32 patients for myelomeningocele-related kyphosis with kyphectomy and posterior instrumentation. During that period, all surgeons used the same indications for the procedure, which were progressive postural decompensation and chronic ulceration at the apex of the deformity. Data were prospectively collected, and all patients who underwent surgery were considered in this retrospective study. The legal guardians of one patient declined to sign the informed consent form, resulting in 31 patients included. A total of 9.7% (3 of 31) were lost to follow-up before the 2-year period, and the remaining 90.3% (28 of 31) were seen at a mean of 3 years (± 9 months) after surgery. The average age was 10 years, 7 months (± 21 months) at the time of surgery. The patients had a mean kyphosis angle of 130° ± 36° before surgery. This technique involved posterior fixation using S-shaped rods inserted through the foramina of S1 and pedicle screws inserted in the thoracic spine. The patients' caregivers answered both the generic and specific (neuromuscular module) Pediatric Quality of Life Inventory questionnaires preoperatively and 2 years postoperatively. The minimum clinically important difference (MCID) considered for the instruments used was 5. RESULTS: Reoperation was performed in 68% of patients (19 of 28), mostly to treat deep infection. In all, 18% of patients (five of 28) underwent implant removal to control infection. Eleven percent (three of 28) had a loss of reduction and pseudarthrosis. The HRQOL increased from 71 ± 11 preoperatively to 76 ± 10 postoperatively (p < 0.001), resulting in a 5-point increase (95% CI 3 to 7) in the generic questionnaire score and from 71 ± 13 to 79 ± 11 (p < 0.001), resulting in an 8-point increase (95% CI 5 to 10) in the neuromuscular Paediatric Quality of Life Inventory questionnaire score, mainly in the physical health domain on both questionnaires. CONCLUSIONS: Kyphectomy was associated with a high risk of complications and reoperations and did not seem to deliver a substantial clinical benefit for patients who underwent the procedure. Most of our HRQOL score improvements were below the minimum clinically important difference for the Pediatric Quality of Life Inventory questionnaires. Although it seems that surgeons lack a better surgical alternative when facing the challenging health impairments these patients suffer, efforts should be made to improve the technique and reduce surgical complications. Additionally, patients and caregivers should be advised of the high reoperation rate and notified that the procedure may not result in a better QOL and should thus be avoided when possible. Future studies should verify whether decreasing the complication rate could imply improvement in the HRQOL of these patients after surgery. LEVEL OF EVIDENCE: Level IV, therapeutic study.